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Klin Padiatr 2014; 226(01): 8-12
DOI: 10.1055/s-0033-1354376
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Colonization and Infection due to Multi-resistant Bacteria in Neonates: A Single Center Analysis

Kolonisationen und Infektionen mit multiresistenten Keimen in einer Neonatologie
R. Haase
1   Department of Pediatrics, University Hospital, Halle (Saale), Germany
,
D. Worlitzsch
2   Institute of Hygiene, University Hospital, Halle (Saale), Germany
,
F. Schmidt
1   Department of Pediatrics, University Hospital, Halle (Saale), Germany
,
R. Kulka
1   Department of Pediatrics, University Hospital, Halle (Saale), Germany
,
A. S. Kekulé
3   Institute for Medical Microbiology, University Hospital, Halle (Saale), Germany
,
D. Körholz
1   Department of Pediatrics, University Hospital, Halle (Saale), Germany
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
28. Oktober 2013 (online)

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Abstract

Background:

In the last years the prevalence of multi-resistant pathogens (MRPs) has increased. Systemic infections remain important for neonatal morbidity and mortality.

Patients:

Neonates born between January 2011 and December 2012 and admitted to the neonatology before their tenth day of life were included into this retrospective analysis. Vancomycin-resistant Enterococci, Methicillin-resistant Staphylococcus aureus, Gram-negative bacilli with Extend Spectrum Beta Lactamase or AMP-C resistance were defined as multi-resistant pathogens (MRPs). MRP positive and negative patients were analyzed regarding clinical risk factors and the incidence of systemic infections.

Results:

635 neonates were admitted during the analysis period. In 31 patients MRPs were detected. 2 patients developed MRP-associated infections. Both were discharged without long term health risks. Low gestational age and need for mechanical ventilation were risk factors for colonization with MRPs in the univariat analysis. The incidence density (per 1 000 patient days) for all MRE increased from 0.76 in 2011 to 3.51 in 2012. In contrast the sepsis rate remained stable (14.9% and 14.2%). 2 MRP colonization clusters were detected by routine microbiology swabs. Both could be controlled by appropriate hygienic measures.

Conclusions:

The prevalence of Gram-negative MRPs increased in neonates. Microbiological screening seems to be helpful for early detection of colonization and thus prevention of nosocomial infections with MRPs. Despite the increased attention towards the problems associated with multiresistant bacteria, there are still major efforts needed for prevention and early treatment of sepsis with non-resistant bacteria.

Zusammenfassung

Hintergrund:

In den letzten Jahren haben sich multiresistente Erreger (MRE) zunehmend verbreitet. Systemische Infektionen tragen signifikant zur Morbidität und Mortalität in der Neonatologie bei.

Patienten:

Retrospektive Auswertung der von Januar 2011 bis Dezember 2012 in den ersten 10 Lebenstagen in die Neonatologie aufgenommenen Neugeborenen. Als MRE wurden Methicillin-resistente Staphylokokken, Bakterien mit „extended-spectrum-Beta-Laktamase“  -Aktivi­tät, AMP-C-Resistenz oder Vancomycin-resis­tente Enterokokken bezeichnet. MRE-positive und -negative Patienten wurden hinsichtlich klinischer Risikofaktoren und dem Auftreten systemischer Infektionen analysiert.

Ergebnisse:

Von 635 untersuchten Neonaten waren 31 mit MRE kolonisiert. 2 Patienten erkrankten an einer MRE-assoziierten Infektion; beide wurden gesund entlassen. Niedriges Geburtsalter und Beatmung waren Risikofaktoren für eine MRE-Besiedelung in der univariaten Analyse. Die Inzidenzdichte für MRE stieg von 0,76 in 2011 auf 3,51 in 2012 an (pro 1 000 Patiententage). Die Sepsisrate für alle Patienten blieb konstant (14,9% und 14,2%). Mittels Routineabstrichen wurden 2 Cluster von MRE-Kolonisierungen entdeckt. Diese wurden durch geeignete hygienische Maßnahmen kontrolliert.

Schlussfolgerungen:

Vor allem im Gram-negativen Bereich wurde eine Zunahme von MRE-Kolonisationen beobachtet. Konsequentes Screening trägt zur frühzeitigen Entdeckung von Kolonisationsclustern und zur Vermeidung nosokomialer Infektionen bei. Trotz aller Sorge über die Ausbreitung von MRE dürfen Maßnahmen zur Vermeidung und frühzeitigen Behandlung der Sepsis bei Neugeborenen mit den schon seit Jahren typischen Erregern nicht vernachlässigt werden.

Key words

multiresistant bacteria - neonate - colonization - neonatal infection

Schlüsselwörter

multiresistente Erreger - Neugeborene - Kolonisierung - Neugeboreneninfektion
 

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